The present disclosure relates generally to infusion therapy with vascular access devices, and relates specifically to infusion therapy with intravenous catheters. Infusion therapy is one of the most common health care procedures. Hospitalized, home care, and other patients receive fluids, pharmaceuticals, and blood products via a vascular access device inserted into the vascular system. Infusion therapy may be used to treat an infection, provide anesthesia or analgesia, provide nutritional support, treat cancerous growths, maintain blood pressure and heart rhythm, or many other clinically significant uses.
Intravenous therapy is facilitated by vascular access devices located outside the vascular system of a patient (extravascular devices). Extravascular devices that may access a patient's peripheral or central vasculature, either directly or indirectly include closed access devices, such as the BD Q-SYTE closed Luer access device of Becton, Dickinson and Company, syringes, split access devices, catheters, and intravenous (IV) fluid chambers. A vascular device may be indwelling for short term (days), moderate term (weeks), or long term (months to years). A vascular access device may be used for continuous infusion therapy or for intermittent therapy.
A common vascular access device is a plastic catheter that is inserted into a patient's vein. The catheter length may vary from a few centimeters for peripheral access to many centimeters for central access. The catheter is commonly incorporated into a catheter adapter to aid in the ease of use, accessibility and utility of the catheter. A catheter adapter is generally a rigid, plastic, tubular member adapted to house one end of the catheter such that one end of the catheter is supported by the catheter adapter, the body and tip of the catheter extending beyond a first end of the catheter adapter. The catheter adapter generally further comprises a second end adapted to receive additional infusion components for use with the catheter. For example, the second end of a catheter adapter may include a set of threads for attaching an intravenous line or for coupling a syringe to the catheter adapter thereby providing access to the patient via the attached catheter.
The catheter may be inserted transcutaneously or may be surgically implanted beneath the patient's skin. When inserted transcutaneously, the insertion of the catheter is commonly aided by a hypodermic needle. The hypodermic needle is commonly housed inside the lumen of the catheter such that the gauge of the needle approximates the inner diameter of the catheter. The needle is positioned within the catheter such that the needle tip extends beyond the tip of the catheter whereby the needle is used to penetrate the patient's vein and provide an opening for insertion of the catheter.
The needle and catheter generally approach the patient's vein at an angle of about 30° wherein the needle initially punctures the patient's skin and then continues into the vein. Once the needle and catheter tip enter the patient's vein, the needle and catheter are then repositioned so that the needle and catheter are brought into a position generally parallel with the patient's vein so that the needle and catheter may be inserted into the lumen of the patient's vein. When the catheter has been properly positioned within the patient's vein, the needle is removed from the lumen of the catheter and the catheter adapter is secured to the patient to prevent premature removal of the catheter.
Typically the catheter adapter is secured to the patient by fastening the catheter adapter to the patient's skin via tape and/or steri-strips. In securing the catheter adapter to the patient's skin, the root region of the catheter must arch to accommodate the catheter's transition from the generally parallel, secured orientation of the catheter adapter, to the insertion angle of the catheter, an angle of approximately 30°. General practice requires that the catheter be inserted into a patient such that an extended section of catheter is left between the patient and the catheter adapter to allow for transitional arching of the catheter.
Several issues exist regarding the need for this exposed, archable length of catheter. First, in making this arch, the catheter is biased towards the patient's skin and thus the root region of the catheter experiences leverage forces wherein the catheter acts as a lever and the first end of the catheter adapter acts as a fulcrum exerting an upward force on the root region of the catheter. This upward force of the first end of the catheter adapter is undesirable due to the likelihood of occlusion of the root region of the catheter against the more rigid catheter adapter. Occlusion typically occurs as the patient and or the catheter is moved thereby increasing the angle of insertion in relation to the fixed position of the catheter adapter. For example, if the repositioning of the catheter and/or patient inserts the catheter further into the patient, the archable length of catheter between the patient and the catheter adapter is decreased thereby increasing the angle of insertion and the upward force of the immobilized catheter adapter on the root region of the catheter. As the angle of insertion increases the upward force of the catheter adapter also increases until such point that the structural rigidity of the catheter is overcome and the catheter kinks in order to continue accommodating the catheter's transition from the catheter adapter into the patient.
Occlusion of the catheter is undesirable as occlusions serve to slow or stop the flow through the catheter thereby creating undesirable backpressures that may cause the infusion system to malfunction and/or be damaged. Additionally, occlusions reduce the efficiency of the infusion system which could effect the treatment and/or diagnosis of the patient.
Second, due to the exposed nature of the arched catheter section, the exposed catheter section may become contaminated and pose a health risk to the patient. For example, an exposed section of catheter may become contaminated and then be inserted into the patient as the patient and/or catheter is readjusted due to normal use by the patient and/or technician. To reduce the likelihood of contamination and subsequent exposure to the patient, technicians seek to minimize the length of exposed catheter by initially over-inserting the catheter into the patient. In reducing the length of exposed catheter, the upward force of the first end of the catheter adapter is increased thereby increasing the likelihood of occlusion within the root region of the catheter.
Contamination of the catheter and/or patient is undesirable for obvious reasons. For example, contamination may lead to secondary infection and/or complications unanticipated by the treating physician. Furthermore, a contaminated catheter may introduce a virus and/or bacteria to the patient that may conflict with the patient's primary therapy such that the patient is unable to receive further needed treatment.
Therefore, a need exists for systems and methods that reduce occlusions at the root region of the catheter, prevent over-insertion of the catheter and prevent contamination of the same.